Exocrine pancreatic insufficiency (EPI) is a digestive disease in which the pancreas doesn’t produce enough enzymes to digest food properly. If you have this condition, you’re probably no stranger to the stomach pain, gas, and diarrhea that can come after eating a meal — especially one containing fatty foods.
In people who have EPI, fat can pass through the intestines without being digested. But you shouldn’t give up fats altogether; a diet for EPI should still provide some healthy fats, says Jamie Lee McIntyre,, a registered dietitian and nutrition communications specialist. In some cases, your doctor or dietitian may recommend getting up to 30 percent of your daily calories from fat.
“Some fat is essential, not just to help meet daily calorie needs, but also to help your body absorb fat-soluble vitamins A, D, E, and K, among other bodily processes,” McIntyre says. “Keeping fat limited to less than 25 to 30 percent of total daily calorie needs per day may work well for most patients with EPI, with a focus on unsaturated fat sources, such as avocado, olive oil, fatty fish, nuts, and seeds.”
Overall, fat and fiber requirements should be tailored to your symptoms and coexisting diagnoses as well as medication side effects, McIntyre says. It’s also important to drink enough fluids, especially if you need to replace water loss from loose stools.
“Diuretic beverages, such as those containing caffeine, should be limited, and alcohol should most definitely be avoided,” she says. Alcohol can contribute to pancreatitis (inflammation of the pancreas).
To lessen gastrointestinal symptoms, you may also want to eat five or six small meals a day instead of the traditional three. Here are some ideas for healthy, quick, and delicious meals.
If you have EPI, you may want to start your day with a bowl of oatmeal made with low-fat milk — a good source of vitamins A and D, which help maintain your immune system and bone strength. Half a cup of rolled oats cooked with 1/2 cup of low-fat milk is about 200 calories.
Add some fixings — blueberries, almond butter, ground flaxseed, or a few walnuts or almonds — to increase the amount of healthy fiber and fats, McIntyre says. “Finely crushed walnuts and almond slivers may be easier to digest, since they are more broken down than whole nuts,” she says.
Fiber helps combat constipation, which can be a common side effect of medication, and bulk up stools, helping to prevent diarrhea, she explains.
Benefit for EPI: Milk provides the extra protein and calcium you need when you have EPI, and nuts contribute fiber and healthy fats.
An omelet made with egg whites and chopped vegetables, served with a slice of whole-wheat toast, is another good breakfast choice when you’re on a diet for EPI. One large, cooked egg nets about 75 calories, but egg whites only have about 17 calories each. The total number of calories in the omelet will depend on which veggies you use; low-calorie options include spinach, tomatoes, and mushrooms. A slice of whole-wheat toast has about 80 calories and provides about 14 grams of carbohydrates.
McIntyre recommends cooking the vegetables until soft and then adding 1/4 cup reduced-fat shredded Cheddar cheese and 1 or 2 whisked eggs. Once cooked, serve with a side of whole-wheat or multigrain toast with a drizzle of olive oil.
Benefit for EPI: Egg whites provide protein, and vegetables supply fiber as well as essential vitamins and minerals. For extra protein and calcium, add in additional low-fat cheese.
03. Taco Salad
For lunch, McIntyre recommends making a taco salad with greens — including spinach, peppers, and onions — 1/4 cup of black beans, and 1/4 cup of avocado. Add some cilantro and four or five tortilla chips for crunch. You can boost the protein in your taco salad by adding grilled chicken, fish, or tofu.
You can also turn this salad into a soup: Heat bone broth, and toss in cooked and shredded skinless chicken breast, brown rice, spinach, finely chopped bell peppers and carrots, 1/4 cup of black beans, and cilantro, McIntyre says. Top with a dollop of fat-free sour cream, fresh cilantro, and a squeeze of lime juice, and serve with a warm corn tortilla on the side.
Benefit for EPI: Avocado is an excellent food, because it provides fiber, beta-carotene, vitamins, potassium, and healthy unsaturated fat.
04. Baked Chicken Breast
Preheat your oven to [suggestion: 325 or 350] degrees Fahrenheit (F). Cover a boneless, skinless chicken breast with a mixture of nonfat plain yogurt and mustard. Add some crumbled whole-wheat pretzels for crunch, and bake until a thermometer reads 165 degrees F. Pair with roasted squash or dark leafy greens, such as kale or spinach.
Benefit for EPI: The chicken provides protein, while the yogurt is a good source of calcium. (It’s a good idea to bake, grill, steam, broil, poach, or even air-fry foods whenever possible. This way, you’ll avoid overdoing it with unhealthy fats, which can go hand in hand with frying or sautéing, says McIntyre.
05. Fish and Wild Rice
Baked fish with wild rice is another healthy meal to include in your EPI diet. McIntyre recommends a light fish, such as cod. Preheat your oven to 350 degrees F. Make a sauce with 1 1/2 tablespoons (tbsp) of Dijon mustard, 1 teaspoon of olive oil, and 1 tbsp of fresh orange juice. Add a dash of dill, salt, and pepper. Bake until cooked, which can take 15 minutes or less, depending on the size of the fish. Serve with 1/2 cup of wild rice and a side of tender cooked vegetables, such as carrots or spinach.
Benefit for EPI: This healthy meal supplies protein, fiber, and heart-healthy fats in the form of omega-3s.
06. Turkey Meatballs
Preheat your oven to [suggestion: 375 or 400] degrees F. Mix ground turkey breast with egg whites, whole-wheat bread crumbs, low-fat grated cheese, salt, pepper, and oregano. Shape into meatballs and bake until cooked through. You can make the meatballs ahead of time, stick them in the fridge, and then warm them up when you’re ready to eat them. Serve with a salad topped with a light oil-and-vinegar dressing.
Benefit for EPI: Meatballs are a good source of protein, and the salad provides fiber.
07. Sliced Apple With Peanut Butter
A healthy diet for EPI can still include fat. One idea for an easy and filling snack is to cut an apple into slices and dip them in a tbsp of peanut butter, which contains about 8 grams of fat. McIntyre recommends peeling the apple if fiber is difficult for you to digest. A banana with peanut butter is another good alternative, she says.
Benefit for EPI: Peanut butter is a healthy fat that provides fiber, vitamins, and minerals, including potassium.
08. Yogurt and Berries
Nonfat Greek yogurt is a great addition to your EPI diet. Mix the yogurt with fiber-rich berries or add some chopped walnuts or almonds for an additional dose of fiber, protein, and healthy fats.
Benefit for EPI: Greek yogurt provides more protein and is lower in carbohydrates than regular yogurt, and the nuts are an easy way to add healthy fats to your diet.
09. Fruit for Dessert
This diet advice is the same for people with EPI as it is for everyone: Skip the cookies and candy to avoid simple sugars and empty calories. A good alternative is fruit salad made with melon, oranges, bananas, apples, and pears. Toss in some grapes or berries if they’re in season, or add toasted almonds or walnuts for a serving of healthy fats and a satisfying crunch.
You can also puree fruit and make homemade ice pops, or add fruit chunks to plain, nonfat yogurt and top it with crushed graham crackers, McIntyre says.
